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Any Functioning Adult: Deconstructing Donald Trump

During a presidential campaign stop in Philadelphia in early June, Joe Biden criticized Trump’s handling of the sometimes-violent nationwide racial protests sparked by the death of George Floyd in Minneapolis, Minnesota. Biden contrasted his leadership style with that of Trump, essentially labeling Trump a narcissist.

Biden quipped, “He [Trump] thinks division helps him. This narcissism has become more important than the nation’s well-being.” Biden mentioned several narcissistic traits he had observed in Trump, including:

· More interest in power than in principle

· More worried about himself than the nation

· Fear and finger-pointing rather than hope and the pursuit of happiness

· Self-absorption and selfishness

The essential feature of narcissistic personality disorder (NPD) is a pervasive pattern of grandiose thinking or behavior, a constant need for admiration, and a lack of empathy. Mr. Trump appears to fulfill those criteria and others outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Armchair Psychiatry

I won’t speculate about the veracity of Mr. Trump’s diagnosis of NPD because I have never done a clinical evaluation of him and therefore it would be unprofessional to state an opinion about his mental health.

Under the American Psychiatric Association’s (APA) Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, it is unethical for a psychiatrist to offer a professional opinion of a public figure unless the psychiatrist has personally examined the individual and has been authorized to release a statement. Restraint of psychiatrists’ comments on political candidates is grounded in APA’s attempt to quash psychiatrists’ opinions about whether senator Barry Goldwater was psychologically fit to serve as President of the United States in 1964.

The ethical tenet known as the “Goldwater Rule” went into effect in 1973. However, when the Goldwater Rule was introduced, we didn’t have abundant video tape, tweets, statements, and written expressions of a candidate as we do today. Even though the practice of “armchair psychiatry” was again disavowed by the APA in 2018, it is clear that long-term observations of an individual’s behavior can be a powerful complement to in-person interviews in arriving at a diagnosis.

In fact, Trump’s demeanor and comments became a lightning rod for psychiatric commentary and critique soon after he took office. He was described as reckless, destructive, out of control, negligent, sadistic, corrupt, and psychologically unfit to lead the United States both domestically and internationally. Some mental health professionals warned of a God-complex and near-psychotic levels of delusional thinking.

A Pivotal Month

In retrospect, June of 2020 and the July 4th holiday weekend may well be viewed as a pivotal stretch for Mr. Trump in his bid to gain re-election. During this time his reactions to a series of quickly unfolding events revealed serious psychopathology and major personality flaws, and his ratings plummeted. For example:

· He boasted of “the greatest comeback in American history” in the face of crises he helped create or inflame ⎯ the coronavirus pandemic; a sputtering economy; recurring police murders of black Americans; and a host of beleaguered relationships including governors, military brass, foreign dignitaries, and the World Health Organization.

· He viewed decreasing unemployment “a tremendous tribute to equality” even though primarily white workers had driven gains in the workforce. (African Americans and other minorities had been disproportionately furloughed.) He called ‘Black Lives Matter’ a “symbol of hate.” He referred to COVID-19 by the racial slur “Kung Flu.”

· He told the Wall Street Journal he deserves credit for making Juneteenth (June 19) “very famous.” However, he was unaware that his White House had been putting out public statements commemorating the day, which marks the end of slavery in the United States, throughout his tenure in office.

· He believed Americans were “starting to feel good now” yet the majority were anxious about the pandemic and worried about catching COVID-19. And as the death toll from the coronavirus skyrocketed, Trump’s focus appeared to be elsewhere — notably, on the “radical left” and his re-election.

· He refused to wear a mask in public, presided over several ill-advised large-crowd gatherings, and claimed that 99% of coronavirus cases are “totally harmless…we’ve learned how to put out the flame.” Trump also suggested COVID-19 would “disappear” and reported that reopening America “saved millions of lives…the one thing that the pandemic has taught us is that I was right.”

How is it possible that Mr. Trump was always “right?” How did he put a positive spin on the economy and coronavirus? How did credible news become “fake” and incontrovertible events a “hoax?” How did Trump succeed in lavishing praise upon himself and taking credit where none is due? All of this and more while distorting the facts, espousing racist views, sending mixed messages about COVID-19, ignoring medical risks inherent in attending his rallies, and peddling conspiracy theories in support of police brutality and hate groups.

Manufactured Outcomes

The answer lies in the way individuals with NPD manage to manipulate or manufacture outcomes through superlative language and language to insinuate various untruths. Trump’s litany of accomplishments while in office have been meteoric. But his proclamations of greatness are baseless.

President Obama’s interpretation of events in the Trump White House “suggests facts don’t matter, science doesn’t matter. That suggests that a deadly disease is fake news.” Colin Powell told CNN: “He [Trump] lies about things, and he gets away with it because people will not hold him accountable.” CNN’s own investigation revealed that Trump “continually conflates his own personal interests — especially for purposes of re-election and revenge against perceived critics and political enemies — with the national interest.”

In his book “The Room Where It Happened,” John Bolton regularly includes phrases like [“the opposite of the truth”] following some quote from Trump. When Bolton was asked by ABC News correspondent Martha Raddatz if Trump is lying about whether aid to Ukraine was tied to investigations into Democrats, including the Bidens, the former National Security Advisor replied: “Yes he is and it’s not the first time either.” Washington Post opinion writer Jennifer Rubin advised, “Save Time: Assume Trump is Inept and Lying.”

The ‘Art of the Deal’

Apparently, lying is the real “art of the deal” Mr. Trump has mastered, especially reshaping the narrative to make himself look better in the eyes of the public. Most of us have lied at one time or another. The narcissist, however, is a chronic liar. It isn’t just what they do, it is who they are. Their cognitive distortions of events, people and history make them feel absolutely justified and entitled to behave the way they do without acquiescing to the truth.

Narcissists hold steadfast to their own version of the truth. They lack a moral compass to distinguish right from wrong. No topic is off-limits, especially when lying can serve their interests and if they think they can profit from omitting or altering the truth. Because narcissists are not introspective, they may be unaware of their distortions and incapable of accepting responsibility for their actions, blaming others instead. Is it any wonder that turnover in Trump’s administration has outpaced his five predecessors by a significant margin?

Temperament and Character

John Kelly remarked, “I think we should look at people that are running for office and put them through the filter: What is their character like? What are their ethics?” He was speaking about Trump.

Personality disorders do, in fact, manifest through temperament and character. They begin in late adolescence or early adulthood and, in the case of NPD and similar personality disorders, e.g., antisocial and borderline personality disorders, they assume the appearance of dramatic, emotional, or erratic behavior. NPD is enduring and difficult to treat because narcissists rarely recognize they need help— quite the opposite, they feel intellectually and socially superior to others.

As individuals with NPD reach late-life, they may have special difficulties adjusting to declining physical attractiveness or new physical limitations. Trump has gone into inordinate detail to explain perceived episodes of weakness — his awkward walk down the ramp at West Point, his mispronunciation of the names of iconic generals, and his odd double-handed drink from a glass of water. Trump’s radiant, at times bizarre, suntan; peculiar hairstyle and color; long silk ties (to hide his gut); and identification with the Lone Ranger (when masked) are emblematic of his vanity, a sign that physically he struggles to retain his masculinity.

History Repeats Itself

Historically, beginning with DSM-III in 1980, the concept of “mental illness” was predicated on whether the condition caused distress in individuals or whether it interfered with their overall functioning. The same thinking holds true today. Although many successful individuals display narcissistic traits, only those with the disorder exhibit behavior regarded as inflexible, maladaptive, and persistent, causing significant impairment in social, interpersonal and occupational functioning.

In addition, DSM-5 has proposed an alternative model for diagnosing NPD in which the level of impairment in personality functioning is paramount. Trump has acted on his own ego rather than any sort of consistent political or health strategy or message, undermining democracy, deeply dividing the country, and imperiling foreign relations and national security.

Coping Skills

Some doctors question whether Trump is bad for their patients’ health. Patients obsess about Trump; their blood pressure goes up when they think about his machinations or manipulations. What guidance should doctors give their patients to help them cope? It’s a difficult question to answer, and fortunately one that may not need an answer now that the election is close.

For my part, I’ll put out my garden flag. It reads: “Any Functioning Adult For President in 2020.” Hopefully, the majority of voters will agree.

Physician, author, speaker, wellness advocate